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COVEGSHNN (2)
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2500 – Emergency Response Program
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COVEGSHNN (2)
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Last modified
3/23/2022 4:03:04 PM
Creation date
3/23/2022 3:55:34 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2500 – Emergency Response Program
RECORD_ID
COVEGSHNN
PE
2546
STREET_NUMBER
3031
STREET_NAME
NAVY
STREET_TYPE
DR
City
STOCKTON
Zip
95206
APN
14502007
ENTERED_DATE
1/12/2021 12:00:00 AM
SITE_LOCATION
3031 NAVY DR
RECEIVED_DATE
1/12/2021 12:00:00 AM
P_LOCATION
01
P_DISTRICT
001
QC Status
Approved
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EHD - Public
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Soecial Waste Profile REPUBLIC• to SERVICES <br />VI, Certification <br />I hereby certify that to the best of my knowledge and belief, the information contained herein is a true, complete and accurate <br />description of the waste material being offered for disposal and all known or suspected hazards have been disclosed. All Analytical <br />Results/Material Safety Data Sheets submitted are truthful and complete and are representative of the waste. <br />I further certify that by utilizing this profile, neither myself nor any other employee of the company will deliver for disposal or attempt <br />to deliver for disposal any waste which is classified as toxic waste, hazardous waste or infectious waste, or any other waste material <br />this facility is prohibited from accepting bylaw. I shall immediately give written notice of any change or condition pertaining to the <br />waste not provided herein. Our company hereby agrees to fully indemnify this disposal facility against any damages resulting from this <br />certification being inaccurate or untrue. <br />I understand that attaching an electronic signature, I am signing this document, consent to complete this transaction and receive all <br />related communication electronically, and agree this document will be binding as though I had physically signed it. A printout of this <br />document may be accepted with the same authority as the original. <br />If electronic signature is preferred, please submit completed (unsigned) form to your Special Waste Coordinator or Special Waste Sales <br />Executive to initiate signature process. <br />I further certify that the company has not altered the form or content of this profile sheet as provided by Republic Services. <br />Michael Anderson <br />Authorized Representative Name <br />(Printed) <br />Technical Project Engineer <br />Title <br />(Printed) <br />Yara North America <br />Company Name <br />2/22/2021 7L,6JLeMoL <br />Representative Signature Date <br />Page 3 <br /> Yara North America Non-Hazardous Waste Solid (Soil) April 2019
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